Smith Sonali M, van Besien Koen, Carreras Jeanette, Bashey Asad, Cairo Mitchell S, Freytes Cesar O, Gale Robert Peter, Hale Gregory A, Hayes-Lattin Brandon, Holmberg Leona A, Keating Armand, Maziarz Richard T, McCarthy Philip L, Navarro Willis H, Pavlovsky Santiago, Schouten Harry C, Seftel Matthew, Wiernik Peter H, Vose Julie M, Lazarus Hillard M, Hari Parameswaran
Department of Medicine, The University of Chicago, Chicago, Illinois 60637, USA.
Biol Blood Marrow Transplant. 2008 Aug;14(8):904-12. doi: 10.1016/j.bbmt.2008.05.021.
We determined treatment-related mortality, progression-free survival (PFS), and overall survival (OS) after a second autologous HCT (HCT2) for patients with lymphoma relapse after a prior HCT (HCT1). Outcomes for patients with either Hodgkin lymphoma (HL, n = 21) or non-Hodgkin lymphoma (NHL, n = 19) receiving HCT2 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) were analyzed. The median age at HCT2 was 38 years (range: 16-61) and 22 (58%) patients had a Karnofsky performance score <90. HCT2 was performed >1 year after HCT1 in 82%. The probability of treatment-related mortality at day 100 was 11% (95% confidence interval [CI], 3%-22%). The 1-, 3-, and 5-year probabilities of PFS were 50% (95% CI, 34%-66%), 36% (95% CI, 21%-52%), and 30% (95% CI, 16%-46%), respectively. Corresponding probabilities of survival were 65% (95% CI, 50%-79%), 36% (95% CI, 22%-52%), and 30% (95% CI, 17%-46%), respectively. At a median follow-up of 72 months (range: 12-124 months) after HCT2, 29 patients (73%) have died, 18 (62%) secondary to relapsed lymphoma. The outcomes of patients with HL and NHL were similar. In summary, this series represents the largest reported group of patients with relapsed lymphomas undergoing SCT2 following failed SCT1, and with long-term follow-up. Our series suggests that SCT2 is feasible in patients relapsing after prior HCT1, with a lower treatment-related mortality than that reported for allogeneic transplant in this setting. HCT2 should be considered for patients with relapsed HL or NHL after HCT1 without alternative allogeneic stem cell transplant options.
我们确定了先前进行过自体造血干细胞移植（HCT1）后淋巴瘤复发的患者接受第二次自体造血干细胞移植（HCT2）后的治疗相关死亡率、无进展生存期（PFS）和总生存期（OS）。分析了向国际血液和骨髓移植研究中心（CIBMTR）报告的接受HCT2的霍奇金淋巴瘤（HL，n = 21）或非霍奇金淋巴瘤（NHL，n = 19）患者的结局。HCT2时的中位年龄为38岁（范围：16 - 61岁），22例（58%）患者的卡诺夫斯基体能状态评分<90。82%的患者在HCT1后>1年进行了HCT2。100天时治疗相关死亡率为11%（95%置信区间[CI]，3% - 22%）。PFS的1年、3年和5年概率分别为50%（95%CI，34% - 66%）、36%（95%CI，21% - 52%）和30%（95%CI，16% - 46%）。相应的生存概率分别为65%（95%CI，50% - 79%）、36%（95%CI，22% - 52%）和30%（95%CI，17% - 46%）。在HCT2后中位随访72个月（范围：12 - 124个月）时，29例（73%）患者死亡，18例（62%）死于淋巴瘤复发。HL和NHL患者的结局相似。总之,该系列代表了报道的最大一组在SCT1失败后接受SCT2且有长期随访的复发性淋巴瘤患者。我们的系列研究表明，SCT2对于先前HCT1后复发的患者是可行的，其治疗相关死亡率低于该情况下同种异体移植报道的死亡率。对于HCT1后复发的HL或NHL患者，若无其他同种异体干细胞移植选择，应考虑HCT2。
